NUR2392 Multidimensional Care II Exam
2
Uncompensated - ANSpH and one other value is abnormal
Partial compensation - ANSpH, CO2, and HCO3 are all off
Full compensation - ANSpH is normal
Acidosis - ANSreduces the excitability of cardiovascular muscle, neurons, skeletal muscle, and
smooth muscle.
Alkalosis - ANSincreases the sensitivity of excitable tissues allowing them to OVERRESPOND
without stimulation
ABG considerations - ANS- Assess cardiovascular w/ acidosis (cardiac arrest from
hyperkalemia)
- Assess neuro status
- Fall precautions
Bicarb HC03 - ANSkidney compensation (slow and powerful)
Respiratory PaC02 - ANSRespiratory compensation (fast but limited)
Metabolic acidosis causes - ANSDKA, Starvation, diarrhea, kidney failure, dehydration, liver
failure, pancreatitis, heavy exercise, seizure activity, fever, hypoxia, ischemia, ethanol/methanol
intoxication
Metabolic acidosis signs and symptoms - ANSbradycardia, hypotension, thready pulse, CNS
depression, hyporeflexia, kussmal resp (with resp compensation), warm, flushed, dry skin.
Metabolic acidosis treatment - ANShydration and medication to treat underlying problems (DKA
- give insulin).
Metabolic alkalosis causes - ANSantacids, blood transfusion, sodium bicarbonate, total
parenteral nutrition (TPN), prolonged vomiting, nasogastric suctioning, hypercortisolism,
hyperaldosteronism, Loop/Thiazide diuretics.
Metabolic Alkalosis s/s - ANSanxiety, irritability, tetany, seizures, POSITIVE CHVOSTEK,
POSITIVE TROUSSEAU, parathesis, hyperreflexia, muscle cramping/twitching, skeletal muscle
, weakness, Tachycardia, norm/low BP, increased Digoxin toxicity, decreased respiratory effort
(muscle weakness).
metabolic alkalosis treatment - ANSrestore fluid/electrolyte imbalances
Respiratory acidosis cause - ANSOpioids, anesthetics, electrolyte imbalance, inadequate chest
expansion, muscle weakness, airway obstruction, alveolar-capillary block.
Respiratory acidosis s/s - ANSbradycardia, hypotension, thready pulse, CNS depression,
hyporeflexia, ineffective respirations, pale-to-cyanotic dry skin.
Respiratory acidosis treatment - ANS(Assess airway) Improve gas exchange, drug therapy
(bronchodilators, anti-inflammatory), oxygen therapy (lowest flow possible), ventilation.
Respiratory alkalosis cause - ANSHyperventilation (fear, anxiety), mechanical ventilation,
salicylate toxicity, high altitudes, early-stage acute pulmonary issues.
respiratory alkalosis s/s - ANSanxiety, irritability, tetany, seizures, POSITIVE CHVOSTEK,
POSITIVE TROUSSEAU (hypocalcemia), parathesis, hyperreflexia, muscle cramping/twitching,
skeletal muscle weakness, Tachycardia, norm/low BP, increased Digoxin toxicity,
hyperventilation
respiratory alkalosis treatment - ANSrestore fluid/electrolyte imbalances
How do acid/base imbalances affect electrolytes - ANS- Potassium levels increase in acidosis
as the body attempts to maintain electroneutrality during buffering.
- Potassium is elevated in acute respiratory acidosis and normal/low in chronic respiratory
acidosis when kidney compensation is present
- Alkalosis = hypocalcemia and hypokalemia
- Acidosis = HYPERkalemia
alkalosis - ANShypocalcemia and hypokalemia
acidosis - ANSHYPERkalemia
Upper GI consists of - ANSmouth, pharynx, esophagus, stomach, and duodenum.
Barret's Epithelium - ANSpremalignant; columnar epithelium that develops in lower esophagus
Zollinger-Ellison syndrome (dumping syndrome) - ANShappens in PT with gastrectomy, from
rapid emptying of food contents into the small intestine.
Dumping syndrome S/S - ANSnausea, distension, cramping pains, diarrhea within 15 minutes
after eating
2
Uncompensated - ANSpH and one other value is abnormal
Partial compensation - ANSpH, CO2, and HCO3 are all off
Full compensation - ANSpH is normal
Acidosis - ANSreduces the excitability of cardiovascular muscle, neurons, skeletal muscle, and
smooth muscle.
Alkalosis - ANSincreases the sensitivity of excitable tissues allowing them to OVERRESPOND
without stimulation
ABG considerations - ANS- Assess cardiovascular w/ acidosis (cardiac arrest from
hyperkalemia)
- Assess neuro status
- Fall precautions
Bicarb HC03 - ANSkidney compensation (slow and powerful)
Respiratory PaC02 - ANSRespiratory compensation (fast but limited)
Metabolic acidosis causes - ANSDKA, Starvation, diarrhea, kidney failure, dehydration, liver
failure, pancreatitis, heavy exercise, seizure activity, fever, hypoxia, ischemia, ethanol/methanol
intoxication
Metabolic acidosis signs and symptoms - ANSbradycardia, hypotension, thready pulse, CNS
depression, hyporeflexia, kussmal resp (with resp compensation), warm, flushed, dry skin.
Metabolic acidosis treatment - ANShydration and medication to treat underlying problems (DKA
- give insulin).
Metabolic alkalosis causes - ANSantacids, blood transfusion, sodium bicarbonate, total
parenteral nutrition (TPN), prolonged vomiting, nasogastric suctioning, hypercortisolism,
hyperaldosteronism, Loop/Thiazide diuretics.
Metabolic Alkalosis s/s - ANSanxiety, irritability, tetany, seizures, POSITIVE CHVOSTEK,
POSITIVE TROUSSEAU, parathesis, hyperreflexia, muscle cramping/twitching, skeletal muscle
, weakness, Tachycardia, norm/low BP, increased Digoxin toxicity, decreased respiratory effort
(muscle weakness).
metabolic alkalosis treatment - ANSrestore fluid/electrolyte imbalances
Respiratory acidosis cause - ANSOpioids, anesthetics, electrolyte imbalance, inadequate chest
expansion, muscle weakness, airway obstruction, alveolar-capillary block.
Respiratory acidosis s/s - ANSbradycardia, hypotension, thready pulse, CNS depression,
hyporeflexia, ineffective respirations, pale-to-cyanotic dry skin.
Respiratory acidosis treatment - ANS(Assess airway) Improve gas exchange, drug therapy
(bronchodilators, anti-inflammatory), oxygen therapy (lowest flow possible), ventilation.
Respiratory alkalosis cause - ANSHyperventilation (fear, anxiety), mechanical ventilation,
salicylate toxicity, high altitudes, early-stage acute pulmonary issues.
respiratory alkalosis s/s - ANSanxiety, irritability, tetany, seizures, POSITIVE CHVOSTEK,
POSITIVE TROUSSEAU (hypocalcemia), parathesis, hyperreflexia, muscle cramping/twitching,
skeletal muscle weakness, Tachycardia, norm/low BP, increased Digoxin toxicity,
hyperventilation
respiratory alkalosis treatment - ANSrestore fluid/electrolyte imbalances
How do acid/base imbalances affect electrolytes - ANS- Potassium levels increase in acidosis
as the body attempts to maintain electroneutrality during buffering.
- Potassium is elevated in acute respiratory acidosis and normal/low in chronic respiratory
acidosis when kidney compensation is present
- Alkalosis = hypocalcemia and hypokalemia
- Acidosis = HYPERkalemia
alkalosis - ANShypocalcemia and hypokalemia
acidosis - ANSHYPERkalemia
Upper GI consists of - ANSmouth, pharynx, esophagus, stomach, and duodenum.
Barret's Epithelium - ANSpremalignant; columnar epithelium that develops in lower esophagus
Zollinger-Ellison syndrome (dumping syndrome) - ANShappens in PT with gastrectomy, from
rapid emptying of food contents into the small intestine.
Dumping syndrome S/S - ANSnausea, distension, cramping pains, diarrhea within 15 minutes
after eating
